CT Perfusion
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0374-CT Perfusion
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CA0374-CT Perfusion
Case ReportHistory
Exam
Prior Study
There is focal hyperdensity in the distal basilar apex consistent with acute thrombus.
There is no discernable cytogenic edema, and certainly no obvious edema to confirm stroke outside the treatment window.
There is focal tissue (minimal) volume loss in the caudal right cerebellum likely from prior ischemic event.
Findings
CT perfusion
CT perfusion demonstrates minimally prolonged TTP & MTT in all structures in the posterior fossa and in the occipital polar areas; the remaining cerebrum was normal. However, the CBF is normal and the CBV is actually increased in all areas (occipital polar and most of the cerebellum) which indicates that at time of the exam there was likely reflow and physiologic hyperemia.
There is focal prolonged TTP in the caudal Rt. cerebellum with diminished CBF & CBV consistent with chronic ischemic change, as seen on the noncontrast CT.
The included post contrast head CT does demonstrate opacification of the proximal afferent arteries, but not of the basilar apex, which contains intraluminal acute thrombus. PCA’s fill retrograde from circle of Willis accounting for the delayed TTP and prolonged MTT in both occipital poles.
Impression
2. Delayed PCA filling (prolonged TTP) is related to retrograde PCA filling from the circle of Willis.
3. Chronic reduced CBV is evident in the caudal Rt. cerebellum (Rt. PICA perfusion zone), but no discernable hyperacute stroke is evident.
